DIABETES MELLITUS.docx

**DIABETES MELLITUS** **-** chronic disease where ***PANCREAS*** not produce enough ***INSULIN***. \- metabolic disease by hyperglycemia \- HYPOGLYCEMIA (pag bumaba sugar) **TYPE 1 DM** \- insulin dependent \- juvenile \- childhood onset \- glucose and insulin bind together (healthy) \- occ...

**DIABETES MELLITUS** **-** chronic disease where ***PANCREAS*** not produce enough ***INSULIN***. \- metabolic disease by hyperglycemia \- HYPOGLYCEMIA (pag bumaba sugar) **TYPE 1 DM** \- insulin dependent \- juvenile \- childhood onset \- glucose and insulin bind together (healthy) \- occurs at 9 yr old (uhaw, weight loss) \- 0 - 15% of total population \- beta cells found in pancreas (diabetic) destroy insulin which glucose trap (absence of glucose) **KETONES** - last source of energy pag itech beta cells ay nasira mes **Auto antibodies** - destroy beta cells (islet cell, insulin, tyrosine phosphatase **FATS + KETONES = KETONURIA** **TYPE 2 DM** \- insulin resistance ( have presence of glucose) \- glucose need to consume \- no ketonuria \- adult onset \- obese, pcos, genes, lack of exercise \- 80% of population \- decrease of beta cells ( present but decrease) \- lead to kidney failure if not medicate **PATHO of DM** \* type 1 & 2 = hyperglycemia \* untreated type 2 = non ketotic hyperosmolar state \* over production of glucose leads to dehydration ------------------------------- ----------------------------------------------- TRESHOLD FOR DM DISEASE ASSOCIATED TO DM Polydipsia - increase thirst Neuropathy - sensation of nerves (nervous) Polyphagia - increase hunger Nephropathy - leads to chronic kidney failure Polyuria - increase urination Retinopathy - leads to blindness ------------------------------- ----------------------------------------------- **DIAGNOSE DM** \* HbA1c (glycosylated hemoglobin) long term monitoring (2-3 mons diagnostic) \* Fasting blood sugar \* Oral glucose tolerance test (OGTT) \* Random plasma glucose level \* Symptoms of DM **PRE - DIABETES** \- pangingitim ng leeg etc. (ACANTOSIS NIGRICANS) \- impaired glucose metabolism \- \>45 yr old should be tested for diabetes \- every 3 - 6 months **GESTATIONAL DM** \- any degre of glucose intolerance \- pregnancy onset \- test used OGTT \- cause by metabolic and hormonal changes \- cause by placental hormones \- Obesity and build up visceral fats **BABY IN GDM** \- overweight baby \- hypoglycemic \- jaundice **MOTHER GDM** \- premature birth \- pre-eclamsia \- develop type 2 dm after giving birth **OTHER SPECIFIC CAUSE OF DM** 1. Genetic defects \* Maturity onset Diabetes of Young (MODY) \- runs strongly in family \* Neonatal \- Impaired receptor binding **DISEASE OF EXOCRINE PANCREAS** \- prod hormones regulate blood sugar **Endocrinopathies** - acromegaly and cushing disease 2. Drug/Chemical induced DM \- hypoglycemia \- after CNS \- glucagon only release at 65-70 mg/dl \- observable signs at 50-55 mg/dl **EPINEPHRINE, CORTISOL, GROWTH HORMONE** \- help glucagon increase glucose \- glucose 6 phosphate deficiency type 1 \- cause of hypoglycemia Fasting - 8 to 10 hrs (NPO) Lipid - 10 to 12 hrs Clinical prac - 6 to 8 hrs **GALACTOSEMIA** - increase galactose in blood **POCT** - point of care testing **Blood sugar monitoring** - glucometer, cellular strips (interstitial glucose measuring device) **Capillary** - Blood \>140 mg/dl **Venous** - Glucose - lab used serum/plasma **2 hr post prandial blood glucose** \- FBS 6-8 hrs \- full meal after drawing FBS \- back after 2hrs then collect blood **OGTT** \- drink glucola \- consume glucola within 5 mins \- oral/intravenous glucola \- 50, 75, 100g glucola \- 1.75 multiply ( depends on the weight of the patient) \- NO VOMITING after intake **IVGTT** \- used accurate assessment og the 1^st^ phase insulin release \- glucose given at 0.5g for 5 mins max is 35g, 25mg/dl **GLUCOSE CHALLENGE TEST (GCT)** \- pag nag 3 hrs na yung ogtt, gct nalang sha \- non fasting, and only used as initial screening **OXIDATION METHOD** \- Alkaline copper \- Alkaline Ferric 1. **ALKALINE COPPER REDUCTION** \- Principle : CUPRIC to CUPROUS \* Folin Wu \- phosphomolybdate reagent \- blue color \* Nelson - Somogy \- Arsenomolybdate reagent \- blue color \* Neocuproine \- neocuproine reagent \- yellow - yellow orange color \- product: Cuprous neocuprine complex \* Benedict's Method \- utlize CITRATE/TARTRATE \- detection and quantitation of reducing substance 2. ALKALINE FERRIC \- yelow to colorless ferrocyanide \- inverse colometry method \- the higher the glucose the less the yellow color \* Dubowski \- Ortho-toluidine react to glucose in acidic solution \- green chromogen (schiff base) ENZYMATIC METHOD (method of choice, higher specificity) \- Glucose oxidase \- Hexokinase \- Glucose dehydrogenase 1. Glucose oxidase \- AKA salfern gernserfield method \- trinder reaction \- colometric method \- measures Beta - D - glucose \- CSF and urine specimen samples \- Beta glucose enzyme \- Polarographic method 2. Glucose dehydrogenase \- measures NADH \- Mutarotase enzyme \- measured by spectophotometer 3. Hexokinase \- hexokinase enzyme \- gold standard for detection of glucose **HbA1c** \- specimen: EDTA - venous whole blood\ - rate of formation is directly proportional to plasma glucose concentration \- method of measurement - structure, charge **HPLC** \- high pressure liquid chromatography \- gold standard for detection of HbA1c **AFFINITY CHROMATOGRAPHY** \- separation of mixture compounds \- detection of substance **Hemoglobin test** \- 2x a yr \- 4x a yr when undergo to a theraphy \- safe answer every 4 mons **Glycosylated Albumin** \- 3-6 weeks life span C. peptide test \- formed from pro insulin - insulin \- 1^st^ test to conduct for glucose ref range 5-15;1 c-peptide;insulin **Ketone test** \- purple color reaction \- fresh serum or urine sample **Acetoacitate** - fat oxidation B. **hydroxybutyrate** - ketogenesis **Acetone** - fat metabolism ------------------- --------------- --------------- ------------- TEST NORMAL PRE-DIA DIABETES fbs \126 mg/dl ogtt \200 mg/dl rbs \200 mg/dl a1c 4.2-6.2 % 5.7-6.4 % \>6.5 % capillary glucose \>140mg/dl fructosamine 205-285 mm/l plasma glucose 300-500 mg/dl glucosuria 180 mg/l ------------------- --------------- --------------- ------------- Observable signs for hypoglycemia: 50-55 mg/dl